On the Cover: Host parents Jackie and Nick Alectoridis with Carlos from the Dominican Republic.

Host Families

For the past 36 years Healing the Children (HTC) has created programs and one-time activities to help over 260,000 children and their families, from over 100 countries around the world, with difficult medical conditions hindering their ability to lead productive lives, or in some cases just continuing to live. We have sponsored and organized numerous outbound medical missions; helped link these children with medical resources in other nearby countries; and in those situations where there are no other viable alternatives we are the sponsoring agency and bring these children into the U.S. for the needed medical interventions in partnering pediatric hospitals across the U.S. The HTC “inbound program” has successfully helped over 7,400 children from developing countries during these past 36 years.

HTC's Inbound Program requires inordinate amounts of planning and coordination among our partnering pediatric hospitals, airlines, medical escorts, international partners, and host families. Each willingly donates their time and financial resources, working together to help these children who otherwise would not get the medical help they urgently require. It does "take a village” to help, and without volunteers of all sorts we could not help these children.

In this year’s Annual Report of Healing the Children we wish to highlight the immeasurable contributions of love and support made by our host families. Host families are special people who represent the embodiment of giving of themselves - with no strings attached - to help children from developing countries and act in all ways as a family while these children are in the U.S. for a temporary medical stay.

Children who need to participate in the HTC inbound program are each placed with a host family close to the pediatric hospital who has agreed to accept the child. With rare exceptions, like nursing infants, we usually will only bring the child into the U.S. There are many reasons why this is our time-tested best practice. But entrusting their child to the care of HTC and its inbound program is a sacrifice that parents willingly make even though it is emotionally unsettling for all involved.

This means we need a host family willing and able to take this child into their homes, make them part of their family for the duration of their stay, help shepherd them through our complex healthcare system, take them to all medical appointments, and provide the in home care necessary for a full recovery so they can then be returned to their home country and their waiting families as soon as practical.

Serving as a host family may be the ultimate exercise, and challenge, of human kindness! Over and beyond all of the other activities and challenges that exist within a family, our host families now are willing to help a child they have never previously met, who usually speaks another language if they speak at all, has existing handicaps of all manner, creates another set of needs competing with those of the existing family, and arrives very scared and unsure after exhausting travel usually for the first time on an airplane, in a country far from home, without the only family they have ever known. This host family relationship requires the entire receiving host family to really want to do this and help a child who very much needs their help, and to initially overcome language and cultural barriers for what can be an extended period of months.

Despite all of those apparent obstacles, Healing the Children’s inbound program is very successful because of the families who volunter and are selected to serve as host families. Amazingly, many of our host families sign up to repeat their experience with additional children!

Here are a few examples of the actual experiences of our host families. Succinctly put, what they do is human kindness of a personal nature at its very finest!

Host Family Spotlight

Healing the Children New Jersey has been successful in treating hundreds of children in New Jersey through our International Inbound Program. We are fortunate to have surgeons and hospitals who continue to believe in the work we do in this program and welcome the opportunity to partner with HTCNJ to make a huge difference in the life of a child in need. But it is our Host Families, who open their hearts and their homes to these children that are the backbone of the program. Without them, we could not continue. We would like to highlight one very special family!

Jackie & Nick Alectoridis have a large extended family of their own. Like most people, they also have very busy lives. Nick has two jobs. Jackie runs a Montessori School. But they always have room and time for one more child. Together, with the support of their children, relatives and friends, they have hosted 9 children over a span of 20 years.

The children they host not only receive top notch medical care, but what they receive from this family is equally important. The children are welcomed and accepted into their family from the minute they first meet at the airport. They love and care for the children as if they are one of their own and are made to feel comfortable and secure during a time when they are sick, scared and missing their families.

Their compassion, sympathy and love for the children they host is remarkable and admirable. They are always willing to do what it takes to make sure that the child is well cared for - no matter how long it takes. They have not always had an easy time with some of the children. There have been difficult personalities, long adjustment periods, medical complications and some very emotional times; but they are all handled with grace, understanding and compassion.

If you ask Jackie why she volunteers as a host family, she will tell you:

Being a host family is something that is part of us. Every child that has stayed with us has become a part of our family. When I think about how each child's life is changed because of the work that Healing the Children does, I think about our own children and what that would mean to us... and what it does mean to us because of how much we love each of these children. One child at a time... every one is worth it and hopefully we change the lives of many children and impact the world for the best.

We are so grateful for all the families that volunteer for HTC. With changes in the economy, the deliverance of healthcare and the changes in family dynamics, we as an organization know that we need to adjust to these changes to keep the Inbound Program viable. We are ready and willing to meet these in order to continue to help children receive the medical care they need and deserve. And knowing these families and having them as part of our "team" encourages and inspires HTCNJ to move forward.

Poem for a Host Family

The little girl said goodbye; her flight would soon depart
To her mom and dad and siblings, from whom she’d be apart.
She’d go a thousand miles from the country where they dwelt.
Sadness, fear, anxiety, were all part of what she felt,
While you waited for her entry into your home and heart.

The health care that she needed was a problem rather large,
Doctors in America said they’d help, and at no charge.
In her native land, she could never get this care,
Her medical condition could not be treated there.
So to host this needy child, your own family would enlarge.

You met her at the airport gate, she had flown so many miles,
And hand-in-hand, walked with her through the crowded aisles.
And off you went together, by car to your abode.
Where she gobbled down a piece of pie served a la mode.
And toddled off to bed, her fears replaced by smiles.

The hospital soon asked if you could bring her for some tests,
You watched the nurse put tiny probes upon her legs and chest.
And when the tests had ended with a date of surgery near,
You reassured the child that there was no need to fear.
Yet as that day got closer, how could you not feel stressed?

The medical procedure was quite complex and long
And you could only hope that nothing would go wrong
And when the doctor came to say that all was good and great
This joyous news, so wonderful, was truly worth the wait.
For this little girl, once needy, now was well and strong.

Just a short time later, she was waiting to depart
And leave behind your family, of which she’d been a part.
To journey far away to the land in which she’d dwell,
It now was you who felt so sad, while bidding her farewell.
But this little girl, forever, would remain inside your heart.

Jeff Degner
Illinois/Indiana Chapter Director

HTC Programs: How We Help

In order to accomplish our mission to serve children, Healing the Children has developed several programs to facilitate our work. Chapters may participate in any of the programs that they deem compatible with their resources and local interests.

International Inbound Program (IIB) is where we assist a child with serious medical issues, who doesn’t have the needed pediatric specialty resources in their home country. We bring him/her to the United States for pro-bono treatment within one of our participating pediatric hospitals. Prior to seeking a solution in the U.S., the IIB program first makes an effort to locate solutions in their own country or in another nearby country closer to where the child and the family lives. If that fails then we present the case to participating pediatric hospitals in the U.S.

Medical Teams Abroad Program (MTA) At the invitation of the host country, we assemble a medical team built around the specific pediatric surgical specialty requested. The MTA volunteers work in the local hospitals and clinics with local healthcare providers to screen and provide surgical care in specialties or specific procedures otherwise not available there. Medical trips are usually 7-10 days long. All of our dedicated team members provide pro-bono care for the children, pay their own expenses and use their vacation time for the trip.

Non-Surgical Teams and Special Programs (International and Domestic) This includes dental and non-surgical (medical, dermatology, audiology, etc.) teams in addition to programs that provide medical/surgical equipment, medical supplies, medicines and training for local healthcare providers. Some examples are the provision of hearing devices, eye exams, eyeglasses, immunizations, medical evaluations, support programs for special needs children, and special events to benefit children.

Our Domestic Program assists children here in the United States to acquire medical care, medicines, equipment, and other related needs that fall through the cracks of our existing insurance and social services programs. Since needs vary so greatly between the states, each chapter creates its own unique Domestic Program.

International Medical Assistance Program (IMAP) is a relatively new program where HTC uses collaborative contacts to help find medical care for an international child in a country closer to where he or she lives. Through IMAP, certified facilities and staff have been identified. This program supports the twin objectives of helping to develop medical resources internationally, and providing urgently needed medical help for the children. We believe this program will become increasingly important in the near future.

2015 Program Results

Total Number of Children Helped

Program

2015

1979-2015

International Inbound

23

7413

Medical Teams Abroad

3,923

180,170

Domestic

112

18,625

Non-surgical and Special Programs

2,882

53,735

International Medical Assistance Program

3

228

6,943

260,171

26 Outbound Medical Teams to 11 Countries

Country

Visits in 2015

Bolivia

1

China

1

Colombia

5

Dominican Republic

2

El Salvador

1

Ethiopia

2

Guatemala

3

India

1

Nepal

1

Nicaragua

3

Peru

6

11 Countries

26

10 Non-Surgical Medical Trips to 4 Countries

Country

Visits in 2015

Bolivia

1

Guatemala

4

Honduras

1

Peru

4

4 Countries

10

23 children came to the United States through our inbound program from:

Colombia (1)

Ethiopia (1)

Iraq (1)

Côte d’Ivoire (1)

Guatemala (1)

Nigeria (1)

Dominican Republic (8)

Honduras (4)

Peru (1)

El Salvador (4)

10 Countries

Financial Highlights

2014

2015

Total Assets

$1,659,656

$1,748,061

Total Liabilities

$148,323

$157,883

Net Assets

$1,511,333

$1,590,178

Total Expenses

$16,332,215

$14,997,072

Total Revenues

$16,214,950

$15,034,601

Increase/(Decrease) in Net Assets

($61,984)

$78,845

% Non-Program Overhead

2.42%

2.31%

In 2015, HTC provided urgently needed medical assistance to a total of 6,943 children, and delivered $14.6 million of medical services and supplies.

Over the past 36 years, HTC has now provided medical assistance to 260,171 children and delivered over $712 million of medical services and supplies for children from over 100 countries.

2015 Geographical Impact

6,943 Children Helped

North America

United States 312

Mexico 1

Central America

El Salvador 461

Guatemala 1,321

Honduras 314

Nicaragua 144

Caribbean

Dominican Republic 108

South America

Colombia 1,435

Bolivia 770

Ecuador 112

Peru 1,316

Middle East/Africa

Iraq 1

Côte d’Ivoire 1

Ethiopia 272

Gambia 1

Liberia 3

Nigeria 1

Asia

China 10

India 140

Nepal 220

2015 Highlights

Each chapter of Healing the Children operates autonomously and plans its programs to reflect the volunteer resources available in their chapter’s region and the interests of its volunteers, both medical and non-medical. Healing the Children is also fortunate to have a global network of International Partners located in many of the countries we are able to work in. These International Partners offer invaluable assistance. They help us to identify the needs of children and the pediatric resources in their countries, and they help to navigate the unique local logistics and regulatory issues that must be broached to make our programs successful.

But more than anything else our programs, our outcomes in helping children around the world, are driven by our collective passion and ingenuity. Every year we share examples of this passion, this ingenuity, with readers of this Annual Report. We hope you enjoy these samples of what we accomplished, what makes us continue on to help more and more children, and that perhaps may inspire others to join in our efforts.

Carlos from Colombia

Meet Carlos. Carlos was referred to Healing the Children by volunteers who traveled to his small village in the mountains of Colombia. Carlos was born without an anus and suffered from a severe urological condition. He was 9 years old and still wore diapers. He also had difficulty walking due to his condition. He suffered great embarrassment due to his condition. The children in his village made fun of him and he often felt left out. Carlos was accepted at one of our partner hospitals in Georgia. Carlos returned to Colombia - his medical issues cured - and is off and running with his peers. He now spends his days playing soccer.

Jeslyn from El Salvador

Meet Jeslyn. Jeslyn's father contacted Healing the Children, desperate to help his little girl. Jeslyn lived in El Salvador with her mother and younger sister. Her father who lived in South Florida was a legal resident of the United States and was fighting desperately to get his daughter to the U.S. for treatment of a brain tumor. Jeslyn could not access the care she needed in El Salvador. Healing the Children Florida worked with a local hospital and was able to get Jeslyn to the U.S. to receive her much needed treatment. She is now 2 years brain tumor free.

Deysis from Nicaragua

Her Nicaraguan name was Deysis. We just called her Daisy. The first time we saw her, she was happily nestled in her mothers arms, completely unaware of the large, deforming tumor on her upper lip. Unbeknownst to us, her parents had already spent countless hours searching all over Nicaragua for a doctor who could help their child. Nobody could. But the plastic surgeon on our Healing the Children medical team felt that in America, the job could be done.

The steps needing to be taken to arrange everything for Daisy were time consuming and stressful. First, an American hospital, willing to donate all their services (doctors, nurses, technicians, etc.), had to be found. A host family was screened and lined up, as well as an escort who would accompany her from Nicaragua. Airline reservations were also made. Meanwhile, in Nicaragua, Daisy needed a passport and a U.S. Visa. Her parents had to sign a Power of Attorney form, surgery and photo consent documents, and a minor traveling without parent statement. Just two days before departure, it was discovered that her parents also had to sign an “exit visa” without which Daisy could not leave! Finally, after weeks of preparation, she was ready to go.

Within days of her arrival, Daisy had bonded with her wonderful host family and finally underwent her long-awaited surgery. It was a total success. Her recovery from the operation was amazingly fast, and the change was dramatic to behold.

Daisy before and after surgery

Two weeks later, she returned to Nicaragua and was reunited with her parents, both of whom were overcome with relief and happiness. Estela cried again, this time with tears of joy. We did too.

Healing the Children had helped one pretty Daisy to blossom.

Victoire from Côte d’Ivoire

18-month old Victoire from the Côte d’Ivoire in West Africa was brought to the United States by another NGO for treatment of a terrible looking tumor over her left eye. Unfortunately, once Victoire was in the United States, they found themselves in over their heads. They learned too late that she was suffering from tuberculosis, and the sponsoring hospital backed out, concerned that the case was too difficult.

The Kentucky Chapter of Healing the Children along with our partners at Kosair Children's Hospital agreed to step in and help, but not until the TB infection was under control. Months later, it finally was and the surgeons at Kosair came through.

Victoire underwent surgery by neurosurgery and ophthalmology teams to remove the cyst. She was sent home to her host family, but developed a CSF leak into the eye. Under the circumstances, this was not too surprising and she was readmitted to place an external ventricular drain in order to drain fluid from the brain and give the leak into the eye time to heal. The procedure was successful and the drain was removed approximately two weeks later. Lesions in her brain were determined to be caused by tuberculosis and were not cancerous.

Victoire will be fitted with a prosthetic eye once she has had more time to heal from the surgery. The rest of her care will be handled by the ophthalmology department at the original sponsoring hospital. Eventually, Victoire will return home to her family in Côte d’Ivoire with her main medical issues under control. The eye under that awful looking tumor never was functional, so even the prosthetic will be an improvement to help her look more normal and be better accepted back home.

This was a difficult case that illustrates many of the challenges that can be encountered when working with desperately ill children from abroad. Fortunately, the experience and diligence of the Kentucky Chapter, the support of our national organization, and the skill and professionalism of our medical partners at Kosair were up to the challenge. For one little girl and her family, that means all the world.

Cleft Lip and Palate Mission to Ica, Peru

Dr. Evan Ransom with cleft patient

The Northeast and Northern California divisions of Healing the Children recently completed their third annual cleft lip and palate mission to Ica, Peru. The surgical team, led for the second year by Dr. Evan Ransom, a facial plastic surgeon from San Francisco, CA and Dr. Joseph Rousso, a facial plastic surgeon from the New York Eye and Ear Infirmary, was also comprised of Augustine Moscatello MD, an otolaryngologist practicing in Westchester, NY, Gerald Geldzahler DDS, an oral and maxillofacial surgeon practicing in Livingston, NJ, and Sean Alemi MD, an otolaryngology resident from the University of California, San Francisco. Anesthesia care was provided for the third consecutive year by a stellar group from Cook Children’s Hospital in Fort Worth, TX.

On their first day, the team was enthusiastically greeted by a waiting room full of families and their children, some of whom traveled up to 40 hours to reach The Hospital Regional de Ica. With the assistance of pediatricians, speech and language pathologists, anesthesiologists, nursing staff and several volunteers, the team screened 111 patients this year. From this group, the surgical team successfully completed 57 operations during the week – highlighted by 16 cleft lip repairs, 22 cleft palate repairs, two cleft rhinoplasties, one maxilla advancement, one mandibular distraction, one first stage microtia repair, and an otoplasty for a constricted ear deformity. In addition, the speech and language pathology group was able to work with a large group of previously-repaired patients, as well as children from the community with other oral and speech issues.

The team is already planning for next year, with ongoing efforts to expand patient recruitment and surgical care during the week. To get involved or make a donation, please visit us online at www.htcne.org and www.HTCNorCal.org.

Kimberly from Guatemala

Much of the following story was told to Dr. Michael Mallahan by Kimberly's adoptive mother Brenda, a volunteer translator for our medical team in 2014. Dr. Mallahan tells the story of his encounter with Kimberly.

Kimberly with her adoptive mother

Kimberly was born with a significant hearing loss and did not have access to school like other children. Her mother died at an early age and her father remarried again. Kimberly's stepmother already had 3 daughters and didn't think the family could support another girl. She wanted Kimberly to be put on the street as a prostitute to support the family. Her father got her away and asked Brenda, a local woman that helped with teaching sign language to children, to take Kimberly to live with her. Brenda agreed and taught Kimberly to sign.

I met Kimberly when Brenda brought her to see me on the first pre-surgical screening day. Brenda was there to help as an interpreter. She told me that she had been teaching Kimberly sign language since she didn't have a hearing aid. We examined Kimberly and Pam Spencer, a volunteer audiologist with our team, fit her with hearing aids.

The next morning Brenda came back and told me how excited Kimberly was because she could hear the birds outside the home for the first time ever. Kimberly returned for the rest of the week to help with the young children being fit with hearing aids. Kimberly and Brenda will be helping us this coming November when we return for another surgical trip.

Of course, nothing is ever expected of the children in return for the help they receive. Nonetheless, this is a recurring story throughout the history of Healing the Children, for our patients to go on to become volunteers or to otherwise get involved with helping others.

Jonas from the Dominican Republic

Jonas Roa came to Healing the Children Rocky Mountains in July 2015. He first was found and identified as a potential inbound child when he attended an ENT clinic HTC New Jersey held in the Dominican Republic in October 2014. Jonas drank lye in a household accident when he was 1. 3 years later he still could not eat or drink because his esophagus was scarred from his throat to his stomach. He had been receiving nutrition through his GI feeding tube in his stomach for 3 years.

HTCNJ contacted HTCRM for help finding a surgeon and hospital that could help the child. Contact was made with Dr. Fritz Karrer at the Children's Hospital Colorado and Jonas made the long trip to Colorado. Jonas lived with Ann and Ryan Brown, directors of the Rocky Mountain chapter, and their two small kids who were 6 and 3. Jonas quickly fell into a routine and found his place right between the two children. They were like 3 peas in a pod.

Host families provide a loving, supportive environment for children during treatment.

Jonas had surgery on August 20, 2015. His 6 hour surgery went perfectly. The surgeon was able to remove the scarred esophagus, and used Jonas' stomach to create a new esophagus for him. Jonas stayed in the hospital for 15 days, which were not without complications, but for the most part he healed quickly and well.

On post-op day #13 Jonas took his first drink in 3 years. It was a delight to witness the miracle of modern medicine at work. He loved apple juice and BBQ sauce the most. Jonas spent the next 3 months in intensive (2x wk) swallow therapy where they taught him how to manage volume of food in his mouth, textures and swallowing, all are natural skills a young child learns when all their body parts work. He soared through therapy and quickly began to eat everything in sight. Favorite foods include Pringles, coleslaw, and popsicles.

Jonas returned home to the Dominican Republic at the beginning of December. We were sad to see him go, but so happy to have been a part of his medical transformation.

Jonas eating through a GI feeding tube.Drinking for the first time in 3 years.

Mildred in Spokane

February 14th, 1983 was indeed a very special day for our family. That day we welcomed our first Healing the Children child from Guatemala. Little that we knew that this little girl would change our lives forever! Since that day we have had the privilege of serving forty-five children from ten different countries. These children came for life threatening surgeries and went home with the gift of life.

Our most recent child - Mildred from Honduras - had two surgeries at Shriners Hospital in Spokane, Washington in May of 2016. She is in the photo with my husband and me before she returned to her family in Honduras.

Healing the Children has been ministry for us and our six children. It has been the greatest blessing a family could receive.

Shirl Lewis
Healing the Children Inland Northwest

Anthony from El Salvador

Anthony with his big brother in El Salvador

Anthony is one of the Healing the Children Southwest Chapter’s international success stories for 2015. From El Salvador, Anthony was born with the life-threatening congenital heart defect Tetralogy of Fallot, making him appear slightly “blue” and causing eating difficulties and his failure to thrive. Without repair of this defect Anthony’s prognosis for survival was grim.

In November of 2015 at 13 months old Anthony arrived in Albuquerque, NM from El Salvador. His life-saving cardiac surgery was donated by Presbyterian Hospital cardiac surgeon Dr. Carl Lagerstrom who has donated his surgical skills to HTCSW for over fifteen years. Anthony's stay in Albuquerque was supported by a team of loving, committed doctors, nurses, administrators and community members. Our late, beloved board member and “HTC Warrior” Bobbye Krehbiel and the current President of HTCSW, Dr. Rifka Stern, coordinated Anthony’s visit.

During his six weeks in Albuquerque, Anthony and his mother lived with local host Louise Kahn CRNA. Anthony became a bit of a local celebrity and was recognized around town after he was featured on the front page of the Albuquerque Journal newspaper and on the local Univision network. Anthony’s surgical outcome was deemed a huge success and local chapter members had the pleasure of meeting him at a dinner where he charmed everyone with his playful grin and wily charms.

One month after returning home to El Salvador, Anthony’s mother reported that he was eating heartily, thriving and reaching many new developmental milestones... and enjoying life with his older brother.

Marari from Nicaragua

Baby Marari was born in Teotecacinte in northern Nicaragua with bilateral clubfeet. She was referred to us by her father, David, who was treated by Healing the Children, Wisconsin many years ago for the same condition. We consulted with pediatric orthopedic surgeons at Children’s Hospital Wisconsin and they recommended that she be taken to the Mascota Children’s Hospital in Managua in southern Nicaragua. The nonprofit, Miraclefeet who specializes in treating clubfeet has a presence in Nicaragua and they thought Marari could be treated there.

She was accepted as a patient which was wonderful news! This meant that she would receive her treatment in Nicaragua but the hospital was a nine hour bus ride from her home. She needed to make a weekly journey for several months to receive the progressive leg castings, surgery and follow-up care. HTC-WI was delighted to step in to cover the cost of their weekly travel and lodging for Marari and her family during her 8 months of treatment.

Marari before, during and after treatment for club feet.

Nubia from Mexico

Nubia is a 17 year old student from Healing the Children Wisconsin’s Adopt-a-Student program in Citlaltepec, Mexico. She suffered for years with terrible headaches and very poor vision caused by an eye condition called strabismus. She also needed glasses to correct astigmatism. In the spring of 2015, HTC-WI arranged to have Nubia receive surgery in Mexico and then be fitted with her first pair of corrective eye glasses.

Nubia told us that after her surgery she feels like a new person. She is elated that she can now live a normal and active life. Her surgery was made possible in part by a donation from school children in Little Chute, Wisconsin through the Adopt-a-Student program.

Adopt-a-Student Program

Healing the Children Wisconsin formed a collaboration with St. John School in Little Chute, Wisconsin to implement an Adopt-a-Student program in Citlaltepec, Mexico. Families in northeastern Wisconsin have the opportunity to sponsor a child’s educational needs each year. The money that sponsors donate pays for a uniform, shoes, backpack and school supplies for a needy child in this small rural community in Mexico.

Students in Citlaltepec and their sponsors in Wisconsin are encouraged to write to each other to foster an on going relationship. Since the children write in Spanish and the sponsors in English we work with the University of Wisconsin - Fox Valley to translate the letters. Students from St. John School do a yearly fundraiser to help the Citlaltepec schools and to help individual students with medical needs like Nubia.

International Development Project

by Glenn Isaacson, MD, FAAP
Margaretha Casselbrant, MDLewis Katz School of Medicine of Temple University and the Department of Pediatric Otolaryngology, Children’s Hospital of Pittsburgh of UPMC

Stage 1 - Helping the Children

Healing the Children’s involvement in Ethiopia began with a picture. Desma Ferrell, Executive Director of Healing the Children’s Philadelphia branch, had visited Ethiopia and found a pediatric ward in Addis Ababa Ethiopia filled with sad looking children. Each of them had a tracheotomy. She wanted to find a way to help these children and let them eventually go home.

She contacted medical colleagues on her return to Philadelphia with this goal in mind. Thus began the first of 15 semiannual short-term missions to the horn of Africa.

The original intent was to help these particular children. When the team of nurses, anesthesiologists, and pediatric otolaryngologists arrived, they realized that the problem was not lack of equipment or knowledge of a particular surgical technique, but absent infrastructure -- not just medical infrastructure, but national infrastructure. These children had recurrent respiratory papillomatosis not subglottic stenosis. Their hospital had a microscope, microdebrider and a skilled surgeon to care for them. They could not go home because there was no electricity to run a suction pump.

Stage 2 - Helping the Residency

Ethiopia is the second largest nation in Africa by population with more than 96 million people -- half of them children. Realizing that a one-off medical mission would not make a dent, Healing the Children’s team decided to focus on improving quality and capacity in Pediatric Otolaryngology and Anesthesiology.

With the help of a US-trained expatriate Ethiopian pediatrician, the team was introduced to the existing otolaryngologists and anesthesiologists in the country. There were about a dozen of each, mostly located in the capital city of Addis Ababa. There were newly created residencies for otolaryngology and anesthesiology. Working with these existing programs, Healing the Children focused first on patient care and education.

Surgeries were done initially at government hospitals including Tikur Anbessa (Black Lion Hospital), the premier teaching institution in the country. The facilities were in bad repair having been constructed by the Swedish in the 1950s and maintained poorly under the recent communist government. It was difficult to do more than one or two operations in a day. This limited the potential for both education and patient care.

Fortunately, Healing the Children was introduced to another nongovernmental organization (NGO) working in Ethiopia. CURE-International had just built a small specialty hospital following an American model. Though spartan, it was adequately staffed and equipped for orthopedic and plastic surgery. This proved a more productive site for pediatric surgery and resident education.

In the first five years of recurring surgical missions, Healing the Children was able to educate the first classes of Addis Ababa University otolaryngology residents in soft tissue technique, endoscopy, and otology. This was done through a combination of didactic lectures, simulation laboratories using cadaver dissection and animal models, and clinic and OR teaching. The focus was on information transfer rather than volume surgery.

During the same period, Healing the Children also developed a relationship with the Makanissa School for the Deaf. Team physicians and audiologists cared for children with profound hearing loss at this total-communication school providing hearing aids where appropriate and medical care including tympanoplasty for those children with partial hearing losses.

Eventually, the first class of AAU Otolaryngology graduates was sent off to regional hospitals throughout Ethiopia to practice their trade.

Stage 3 - Assessing Impact

While the first years were productive in terms of patient care and basic otolaryngology education, there were obvious problems. The team was only in Ethiopia two weeks out of the year. This was inadequate for good continuing patient care and for education. Eventually, the Healing the Children team learned by word-of-mouth about other NGO teams visiting Ethiopia. We began to coordinate our activities, working together, sharing missions and resources, and developing a curriculum for residency education. Eventually, by sharing donated resources, we were able to put together the first temporal bone laboratory in the horn of Africa and to teach several courses using cadaver temporal bones.

In this third phase of development, it was important to stop and think about whether we were doing the right thing. Clearly, transmission of information to the Ethiopian Otolaryngology residents was a good thing to do. We participated in their Board examinations at the completion of the four-year residency. The students were bright and had learned much. However, while their information bases were good, there were clearly major deficiencies in surgical skills. We needed to do more.

We also wanted to know whether the surgeries we were doing produced good outcomes. As our first collaborative research project with AAU, we reviewed the pre-and postoperative audiograms and surgical results of all of our tympanoplasties. The results were comparable to those reported by developing world surgical programs, though they would have been considered inadequate in Europe or the United States.

Stage 4 - Helping the Graduates - Growing Capacity

Our most recent efforts have been focused on the graduates of the AAU residency. Several of them were assigned to regional hospitals. They tried to practice Otolaryngology and failed. They lacked local support, equipment, and confidence in their surgical skills. To correct these deficiencies, we helped them find postgraduate fellowship training both at sites in Africa, and in the United States. Through the American Academy of Otolaryngology’s visiting scholar program, AAU graduates attended the AAO national meeting and did mini fellowships at Temple University, University of Pennsylvania, SUNY-Syracuse, and Harvard hospitals. Graduates have participated in Head and Neck fellowships in Kenya, Spain, and Senegal.

The lack of surgical instruments and operating microscopes was particularly acute. Healing the Children worked in coordination with several US hospitals and NGOs to find decommissioned instruments and transport them to Ethiopia. It was possible to rehabilitate discarded operating microscopes using alternative power sources and LED lighting. Boeing Corporation and Ethiopian Airlines provided transportation for these heavy items on newly purchased commercial airliners.

The Healing the Children teams visited the hospitals and universities around Ethiopia where the AAU graduates were stationed. We worked with them to help improve their operating room flow. Our audiologists trained Ethiopian nurses to do hearing tests. We operated together with the graduates on difficult cases at their home hospitals and at CURE-Ethiopia to help them develop confidence in their surgical skills.

Healing the Children faculty have worked in coordination with Ethiopian universities and the AAU graduates to develop research skills. Together we determined the prevalence of hearing loss in normal populations and in children with treated HIV. We are studying the causes of sensorineural hearing loss in profoundly deaf children and their siblings.

Healing the Children has moved from the surgical mission model to a newer paradigm. It focuses on transfer of knowledge and technology to Ethiopian physicians. It is hoped that with continuing support, a new generation of otolaryngologists will address the huge need for surgical care in this populous developing country.

How You Can Help

Thank you for reading the stories of many brave children and learning exactly why Healing the Children envisions a world where every child has access to medical care, regardless of circumstance. If you were touched by a story in any way and would like to get involved, Healing the Children would love to hear from you.

Here are a few ways you can help:

Donate. Your donation provides children with the gift of health, so precious and priceless. Donate to Healing the Children right here or visit healingthechildren.org/donate/ for more ways to contribute. Feel free to donate to a specific chapter or to HTC National, which benefits all chapters. As a volunteer-based organization, 98% of every dollar is spent directly to help our children!

Consider volunteering your services or time. Visit healingthechildren.org to find the chapter that is closest to you. Just contact that chapter to learn of specific needs and opportunities in your area. Whether you’re a doctor and want to participate on a medical trip or be a host family to a child, or help become an administrator for our programs, there are many volunteer opportunities for each chapter.

Be a leader and establish a chapter in your area. If you live in an area that is lacking a voice for children in need, we would love to work with and help you establish a new HTC chapter. You do not need a medical background, just the ability to attract medical resources in your city or state, some organizational or non-profit experiences and most importantly, a genuine desire to help heal children who are counting on you. Please contact us and we will discuss the process to establish a chapter in your area.